tbuckley/cabot-search huggingface dataset:
Abstract 11242: Spatial-Temporal Deep Learning for Automatic Detection of Echocardiographic Predictors of Mortality in Patients Hospitalized With Covid-19 - Data From the PROVAR-COVID Study
Authors: Washington Luis S Ramos, Bruno R Nascimento, Gisele L Pappa, Edson R Araújo Júnior, João Francisco B martins, Wagner Meira Júnior, Sander Luis G Pimentel, Juliane Franco, Kaciane Oliveira, Maria D Nunes, Craig A Sable, Andrea Z Beaton, Antonio L Ribeiro, Erickson R Nascimento
Journal: Circulation (2022)

Background: Cardiac involvement seems to impact the prognosis of COVID-19. Bedside echocardiography (echo) holds promise for the early outcome prediction, and artificial intelligence has shown to be an additional tool to overcome personnel limitations. We propose a spatial-temporal deep learning-based approach for automatic prediction of mortality of inpatients with COVID-19 with echo images. Methods: Patients admitted to two hospitals in Brazil in 90 days with confirmed moderate and severe COVID-19 underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid IQ), following admission, with remote interpretation. Independent echo predictors of all-cause mortality were assessed, after adjustment for clinical variables. Our image dataset consists of 752 videos (Mpeg) acquired in three different probe positions: apical 4-chamber and parasternal long and short axis. We predicted the patients’ outcome (discharge or death) in a 10-fold cross-validation procedure manner, where we applied a 2-stream deep neural network composed of 2 identical ResNet-18 Convolutional Neural Networks (CNN) - pre-trained and developed for Rheumatic Heart Disease - followed by attention units to extract relevant spatial and temporal features from RGB and Optical Flow frames. A final softmax layer is used for classification. Results: A total of 163 patients were enrolled, the mean age was 64±16 years, 107 (66%) were admitted to intensive care and in-hospital mortality was 34% (N=56). Independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF&lt;64% (OR=7.37, 95%CI 2.10-25.94), and TAPSE&lt;18.5 mm (OR=9.43, 95% CI 2.57-35.03), C-statistic=0.83. During training, utilizing a balanced set of 106 patients, we rescaled videos to 224x224 pixels and used temporal jittering to select a final clip with 32 frames per video in random batches of size 6. Our proposed method achieved an exam-wise accuracy of 62.22% (95%CI 52.40-72,04), sensitivity of 67.52% (95%CI 51.62-83.42), and specificity of 60.45% (95%CI 45.15-75.75) for mortality. Conclusion: Automatic detection of high-risk echo findings in COVID-19 inpatients at the bedside seems feasible and, with more research, can improve mortality prediction at the point of care.
Abstract 11653: Prolonged Rilonacept Treatment in Rhapsody Long-Term Extension Provided Persistent Reduction of Pericarditis Recurrence Risk
Authors: Massimo Imazio, Allan L Klein, Antonio Abbate, Michael Arad, antonio brucato, Paul C Cremer, Eliyazar Gaddam, Antonella Insalaco, Martin M Lewinter, Basil Lewis, David Lin, Sushil A Luis, Stephen J Nicholls, Paul Sutej, Yishay Wasserstrum, Manoj Samant, Liangxing Zou, Fang Fang, John F Paolini
Journal: Circulation (2022)

Introduction: Rilonacept reduced pericarditis recurrence in the phase 3 trial RHAPSODY. The long-term extension (LTE) enabled further insights into efficacy, safety, and clinical decision making. Methods: The RHAPSODY run-in (RI) and randomized-withdrawal periods were followed by an LTE that enabled open-label rilonacept treatment up to 24 additional months. A decision at 18 months after the most recent recurrence was based on clinical status at investigator discretion: 1) continue rilonacept on-study, 2) suspend rilonacept for observation or 3) discontinue from the LTE without observation. Endpoints included recurrence and quality of life. Results: In May 2020, 74 of 75 eligible subjects continued to LTE; US subjects (n=45) switched to commercial therapy or discontinued in April 2021 (treatment duration from RI baseline [median; maximum] 18; 27 months). Non-US subjects (n=29) completed the LTE in June 2022 (treatment duration from RI baseline [median; maximum] 27; 33 months). Concomitant oral medications during LTE: 22% NSAIDS, 20% colchicine, 0% corticosteroids, 43% none. Inflammation signs (CRP), RP symptoms (PGIPS), and recurrences were low on-treatment. Before the 18-month decision (n=74), there were 3 investigator-assessed recurrences (0.04 per patient-year). At the 18-month decision (n=52), 64% (n=33) continued rilonacept on-study, 15% (n=8) suspended rilonacept for observation, and 21% (n=11) discontinued the study without observation, of whom 7 switched to commercial rilonacept. There was a 75% recurrence rate (n=6/8) in the off-treatment observation group (median time to event 11.8 [3.7, Not-Estimable (NE)] weeks) but only 1 recurrence in subjects on rilonacept (time to event NE [too few events]) associated with a 4-week interruption; HR 0.018, p&lt;0.0001; Fig 1. Conclusions: Continued rilonacept treatment resulted in continued treatment response, whereas treatment suspension at 18 months may be associated with pericarditis recurrence.
Abstract 11746: Decellularized Dermis Extracellular Matrix Alloderm Mechanically Strengthens Biological Engineered Tunica Adventitia-Based Blood Vessels
Authors: Bijal Patel, Bryan Wonski, Saliganan Dan, Ali Rteil, Loay Kabbani, Mai T Lam
Journal: Circulation (2022)

Introduction: Of the three layers of a mammalian artery, the tunica adventitia provides the most strength to prevent rupture of blood vessels under high pressures. The structural network of this outermost layer mainly consists of fibroblasts and collagen. Many groups have improved strength of their tissue engineered (TE) vessels by conditioning with pulsatile flow in bioreactors. Conditioning stimulates cellular collagen production; however, it is time-consuming ranging from 3-8 weeks. Dermis is comprised primarily of collagen providing skin with considerable strength. Hypothesis: We hypothesized inclusion of decellularized dermis, Alloderm, into TE vessels can increase the strength and thus decrease production time. Methods: To generate a TE adventitia vessel, we adapted our lab’s ring stacking method which creates tissue rings that are stacked to form a tubular, vascular constructs. Human dermal fibroblasts (HDFs) were used to form a cellular fibrin hydrogel in a petri dished with a central post. Alloderm was cut into a donut shape and placed on top of the hydrogel around the central post (Figure 1). Additional HDFs were placed on top of the hydrogel and Alloderm. Over 14 days the HDF monolayer rolled around the post into a ring. These Alloderm rings were stacked and adhered using fibrin glue to create a TE vessel. Results: TE vessel tensile strength was significantly higher with Alloderm than without: 1500 ± 262 kPa (n = 5) versus 67.9 ± 9.78 kPa (n = 5). Histology indicated Alloderm significantly increased total collagen content and fiber maturity compared to TE vessels without. Mechanical integrity of Alloderm rings was maintained for 4 weeks: tensile strength 2760 ± 1130 kPa. In comparison, native adventitia strength is 1430 ± 604 kPa. Conclusions: This work shows that decellularized dermis can successfully be incorporated into TE vessels. Additionally, inclusion of Alloderm significantly increases tissue strength and collagen content that is maintained over time.
Abstract 11691: Self-Reported Sodium Intake Identifies a Sodium Vulnerable State With Increased Response to Spironolactone in HFpEF
Authors: Pieter Martens, Wilfried Mullens, James C Fang, Wai Hong Tang
Journal: Circulation (2022)

Introduction: Asking patients about sodium intake is standard practice in heart failure (HF). Hypothesis: Self-reported sodium intake in HF with preserved ejection fraction (HFpEF) reflects a vulnerability to sodium intake driven by aldosterone. Methods: The TOPCAT trial registered self-reported sodium intake at baseline. Cox-regression and linear-mixed models were used to assess the relationship between self-reported sodium intake and outcome. Interaction analysis between self-reported sodium intake and the treatment effect of spironolactone on HF-outcome, blood pressure (BP), dyspnea and edema at follow-up were used to assess sodium vulnerability mediated by an aldosterone effect. Results: Self-reported sodium intake of 1748 HFpEF patients included in TOPCAT were divided according to tertiles of sodium intake (47% low, 35% moderate and 18% reported high sodium intake). After covariate adjustment lower self-reported sodium intake associated with higher risk for HF-admission (p=0.009). Patients with a lower sodium intake demonstrated higher E-wave and LV-end diastolic volume and higher estimated plasma volume (p&lt;0.001). Lower sodium intake was associated with a larger treatment effect of spironolactone on HF-admission (HR=0.69, 95%CI 0.53-0.91 vs highest tertile HR=1.37 95%CI 0.79-2.38, p-interaction=0.030). Additionally, linear-mixed models indicated larger BP-reduction (Figure) and larger reduction in dyspnea and edema (p-interaction all&lt;0.001) in patients with lower sodium intake receiving spironolactone. Conclusions: Low self-reported sodium in HFpEF is associated with volume status and higher risk of HFH. The more pronounced treatment effect with spironolactone on HF-outcome, BP and volume status in patients with the lowest self-reported sodium intake potentially suggests that low self-reported sodium intake is an indicator of a sodium vulnerable, potentially aldosterone driven, state.
Abstract 11251: Canagliflozin Therapy Improves Myocardial Function and Perfusion in a Swine Model of Chronic Myocardial Ischemia
Authors: Sharif A Sabe, Cynthia M Xu, Mohamed Sabra, Ahmed Aboulgheit, Madigan Stanley, Ruhul Abid, Frank W Sellke
Journal: Circulation (2022)

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have cardioprotective effects independent of glucose control, as demonstrated in animal models of acute myocardial ischemia and in clinical trials of patients with heart failure. The mechanisms of these effects require further investigation. The purpose of this study is to determine the effects of canagliflozin therapy on myocardial function, perfusion, and microvessel density in a large animal model of chronic myocardial ischemia. Methods: Yorkshire swine underwent placement of an ameroid constrictor to the left circumflex artery to induce chronic myocardial ischemia. Two weeks later, pigs received either no drug (CON, n=8) or 300mg canagliflozin (CANA) daily (n=8). Treatment continued for five weeks, followed by hemodynamic measurements and harvest. Perfusion, vessel density, and protein expression were measured by microsphere analysis, immunofluorescence, and immunoblotting respectively. Results: CANA therapy was associated with increased stroke volume (p=0.007) and stroke work (p=0.021), and decreased left ventricular stiffness (p=0.007) compared to CON. The CANA group had improved perfusion to ischemic myocardium at rest (p=0.036) and during pacing (p=0.038) compared to CON. There were no differences in arteriolar or capillary density between groups (p&gt;0.5). In ischemic myocardium of the CANA group, there was increased expression of total AMPK (p=0.0047) and p-AMPK (p=0.038), decreased expression of p-eNOS (p=0.028) with unchanged total eNOS (p&gt;0.5), and increased expression of antioxidant SOD2 (p&lt;0.001) compared to CON. There were no differences in expression or activation of AKT and ERK1/2 (p&gt;0.05). Conclusions: In the setting of chronic myocardial ischemia, canagliflozin therapy improves myocardial function and perfusion to ischemic territory, without changes in collateralization. Activation of AMPK and antioxidant signaling may contribute to these effects.
Abstract 11165: Characterization of Heart Failure Patients in an Academic Home Hospital Program and Identification of Patient Factors Requiring Escalation of Care
Authors: Aditya Achanta, Carson Moss, Neelam Phadke, Jason H Wasfy, Ryan W Thompson, Rory B Weiner
Journal: Circulation (2022)

Background: Hospital capacity concerns exacerbated by the COVID-19 pandemic have accelerated growth of hospital at home (HaH) programs. However, for HaH admissions related to heart failure, information on patient characteristics and clinical outcomes remain sparse. We aimed to better characterize heart failure admissions in a HaH model and assess characteristics of patients who later needed escalation of care to a traditional hospitalization. Methods: This retrospective, descriptive study examined HaH admissions for heart failure at an academic medical center between 2017 and 2022. We compared baseline characteristics and outcomes using the Chi-squared test for categorical variables and t-test for continuous variables for patients who required escalation of care to those who did not. Using the same methods, we also compared patients based on their location prior to admission (e.g. emergency department (ED), home). Results: Heart failure was the primary diagnosis for 32% of HaH admissions. The majority of the heart failure cohort (N=199, average age 80.6 years), 73.9%, had heart failure with preserved ejection fraction (HFpEF). Escalation of care to traditional hospitalization was required for 22.6% of patients. 9.0% of patients died within 90 days, and 20.1% and 36.2% of patients were readmitted for any reason within 30 and 90 days respectively. Patients whose care was escalated were more likely to have a history of chronic kidney disease (84.1% vs 66.9%, p=0.043), higher admission BUN (41.5 vs 31.1, p=0.004) and creatinine (1.74 vs 1.41, p=0.011), and a history of PCI (20.5% vs 5.3%, p=0.005). Patients referred directly from home compared to the ED had similar baseline characteristics and rates of 90 day inpatient readmission and mortality. Conclusions: Patients admitted to HaH for heart failure represent a high risk cohort who are commonly older with multiple comorbidities and more likely to have HFpEF. Among this cohort, patients with kidney dysfunction and/or history of percutaneous coronary intervention are more likely to require escalation of care. These results suggest that heart failure patients admitted to HaH who will later need traditional hospitalization could be identified prospectively using these characteristics.
Abstract 11129: Left Atrial Proteomic Signature in Atrial Fibrillation and Advanced Heart Failure
Authors: Ryan G Aleong, Shu Chang, Wendy Tzou, Michael R Bristow
Journal: Circulation (2022)

Introduction: Atrial fibrillation has been shown to have a major impact on outcomes in Heart Failure with reduced Ejection Fraction (HFrEF). Identifying which proteins are differentially expressed may lead to a better understanding of how AF impacts the remodeling and outcomes in HFrEF. Hypothesis: To demonstrate a difference in proteomic analysis of left atrial (LA) tissue in patient with had atrial fibrillation compared to those with no history of atrial fibrillation from explanted hearts of patients with HFrEF. Methods: We compared the protein expression from explanted left atria and left ventricles from HFrEF patients using t-tests to generate a heat map and volcano plots. Patients with any history of AF (paroxysmal or persistent) were compared to patients with no history of AF. We then compared patients in different AF subtypes using ANOVA analysis Results: The group comprised 11 patients with AF and 8 patients with no history of AF with mean age 56±4 yrs, and 68% were males. There were no differences in demographics between the groups. There was differential expression of three atrial proteins between the AF vs. no AF groups: CPA1 (P = 0.01, Panel A), CCL15 (P = 0.02), CPB1 (P = 0.04) [Volcano Plot, Panel B]. When AF subtypes were analyzed there a consistent differential pattern in the proteomic signature from the LA between the three groups in a total of 10 proteins (Panel C). Conclusions: This preliminary data is consistent with different proteomic signatures among HFrEF patients with AF and among different atrial fibrillation subtypes.
Abstract 11740: Online Health Information for COVID 19 Vaccine Induced Myocarditis: Between the Myth and Truth
Authors: Mohammed Abualenain, Andrea De Leon Tejeda, Gurusher S Panjrath
Journal: Circulation (2022)

Objective: COVID-19 vaccine-induced myocarditis is becoming an important topic. As the internet is the leading source of information, it is crucial to evaluate the quality and readability of health information available to the general public as it has an impact on increasing awareness and encourage vaccinations. Methods: The top 30 websites of 2 different search engines (Google, Bing) were collected using the term “Covid vaccine induced myocarditis” on a newly installed Mozilla Firefox browser. Physician-oriented websites, non-relevant content (not connected to the search keyword), and duplicates were all excluded. The quality of the websites were evaluated using the DISCERN tool by two physician reviewers who are knowledgeable and were blinded to each other's findings. After that, the data was evaluated to come up with an aggregated score for each website. Readability was assessed using the Flesch-Kincaid Readability Ease (FKRE) and the Flesch-Kincaid Grade Level (FKGL) tool. Results: A total of 19 websites were assessed after exclusion criteria. The average overall quality for DISCERN was 3.4 out of 5 with a median of 3.46 while the average total DISCERN score was 48.2 out of 80: the highest total quality among them being 63 out of 80. The average FKRE was 48.5 out of 100, while the average FKGL was 8.7 out of 18 with the lowest grade being 6.2. Conclusion: Overall, the quality of the information was rated as moderate or “fair” with an average of 3.4 out of 5. Most of the websites were accurate in the information provided. However, those websites that were high quality did require a higher level of education to be able to comprehend. The average reading grade level was 8.7 grade, which is higher than the average American reads (8th grade). The highest quality website based on DISCERN was Health U.S news. All websites encouraged vaccinations and explained the rarity of getting myocarditis from COVID 19 vaccine.
Abstract 11287: Structural Remodeling Impairs Left Atrial Function in Patients With Atrial Fibrillation: A Cardiac MRI Study
Authors: Yaacoub Chahine, Fima Macheret, Lee Bockus, Joonseok Kim, Nazem W Akoum
Journal: Circulation (2022)

Introduction: Left atrial (LA) fibrosis and enlargement are hallmarks of structural remodeling that contribute to atrial fibrillation (AF) pathophysiology. Cardiac magnetic resonance (CMR) feature tracking has higher spatial resolution and better ability to define the endocardial border, overcoming the challenges related to speckle tracking echocardiography particularly the anatomic location of LA and thinness of the atrial wall. We aimed to assess the association of LA fibrosis and volume with LA function and compliance using CMR imaging. Methods: We analyzed CMR images of AF patients prior to their first catheter ablation. LA fibrosis was assessed using Late Gadolinium Enhancement CMR (Panel A). Feature tracking was applied to assess global longitudinal reservoir strain (GLRS) (Panel B). LA emptying fraction, LA volume index and LA sphericity index were measured using the Cine sequences. All CMR images were acquired in sinus rhythm. Results: 101 patients were included in the study (61% male, mean age 62 years). Median LA volume index was 45.16 mL/m 2 [36.64, 56.5], LA fibrosis percentage was 15.5% [9.6, 19], LA sphericity index was 54.09% [46.44, 64.58] and GLRS was 17.4 [14.95, 20.1]. A Pearson correlation analysis showed that increased LA fibrosis was negatively associated with both GLRS and LA emptying fraction (R=-0.35, p&lt;0.001 and R=-0.27, p=0.007 respectively). LA volume index was also negatively correlated with GLRS and LA emptying fraction (R=-0.37, p&lt;0.001 and R=-0.54, p&lt;0.001, respectively) (Panel C). Neither LA fibrosis nor LA volume index was associated with LA sphericity index (p=0.55 and p=0.4 respectively). Conclusion: LA structural remodeling including increased fibrosis and LA volume is associated with a worsening LA function by strain imaging on CMR. Fibrotic remodeling may lead to blood stasis and play a role in the pathophysiology of thromboembolic stroke associated with AF.
Abstract 11053: Is the Abnormal Rise in Both Systolic and Diastolic Blood Pressure Post-Mild Exercise Protocol Associated With More Cardiovascular Structural and Functional Abnormalities Than Isolated Systolic or Diastolic Rise Alone?
Authors: Mahfouz El Shahawy, Lillee Izadi, Antonella Sabatini
Journal: Circulation (2022)

Background: An isolated abnormal rise in systolic or diastolic BP post-mild exercise protocol (PMEP) is a major CVD risk factor. Purpose: To assess whether a combined abnormal rise in systolic and diastolic BP PMEP is associated with more cardiovascular structural and functional abnormalities (CVSFA) than an abnormal rise in either isolated systolic or diastolic BP PMEP. Methods: We screened 2,924 asymptomatic subjects, ages 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System, also known as the Rasmussen Risk Score, which was published previously. This consists of 10 tests: 7 vascular and 3 cardiac. The vascular tests are large (C1) and small (C2) artery stiffness, BP at rest, and after PMEP, CIMT, abdominal aorta ultrasound, and retinal photography. The 3 cardiac tests are Pro-BNP, ECG, and LV ultrasound. Out of the total subjects, 1106 (38%) were on no medications. These were divided into four BP subcategories according to the current ACC/AHA guidelines, shown in the table. Results: As shown in the table, combined systolic and diastolic BP rise PMEP is more common than either one alone. Systolic and diastolic BP rise PMEP is associated with more CVSFA, particularly in those with Stage 1 and 2 hypertensions compared to those who are normotensive. The CVSFA in combined systolic and diastolic BP PMEP is not statistically significant when compared to isolated abnormal rise in systolic or diastolic BP. Conclusions: Abnormal rise in BP PMEP is associated with significant CVSFA, regardless of whether isolated or combined. Hence, we recommend exercise stress testing protocol for risk stratification and optimal treatment in hypertensive patients.